Healthcare Provider Details

I. General information

NPI: 1679404354
Provider Name (Legal Business Name): ERIN OLIVIA MANUEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MOORE DR STE 205
LEXINGTON KY
40503-2951
US

IV. Provider business mailing address

173 BANYAN BLVD
RICHMOND KY
40475-8370
US

V. Phone/Fax

Practice location:
  • Phone: 859-489-4126
  • Fax:
Mailing address:
  • Phone: 859-948-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4058903
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: